• Network vaccination pharmacy (Many network pharmacies have vaccination pharmacists who may give covered preventive immunizations to members. Contact a network pharmacy ahead of time to make sure the pharmacy has the vaccine you need. Present your UMP member ID card at the pharmacy counter for billing before receiving a vaccine.) • Public health department. The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations. Exception: COVID-19 vaccines are covered when required for employment. TIP: If you get a vaccine from an out-of-network provider, submit your claim to Regence BlueShield as a medical claim (see the “Billing and payment: submitting a claim” section). If you get a vaccine from an out-of-network pharmacy, submit your prescription drug claim to WSRxS (see the "Submitting a claim for prescription drugs" section). If you use an out-of-network provider or an out-of-network pharmacy, services will be paid at the out-of-network rate and you may be balance billed. Vaccines from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” Radiology Preauthorization is required for all non-emergency diagnostic imaging. Providers should obtain preauthorization before scheduling or performing any elective outpatient imaging service. Examples of imaging tests that require a preauthorization are: • Computed tomography (CT) • Computed tomography angiography (CTA) • Magnetic resonance angiography (MRA) • Magnetic resonance imaging (MRI) • Myocardial perfusion imaging (MPI) • Nuclear cardiology: ▪ Blood pool imaging ▪ First pass ventriculography ▪ Infarct imaging ▪ Multiple-gated acquisition (MUGA) scan • Positron emission tomography (PET and PET-CT) Second opinions This benefit covers: • Second opinions you choose to get. The plan covers these under the medical benefit, once you meet your deductible and pay the coinsurance. • Second opinions required by the plan. The plan covers these at 100 percent (you do not have to meet your deductible or pay the coinsurance). If you do not get a second opinion when required by the plan, coverage for services may be denied. 68 2024 UMP CDHP (PEBB) Certificate of Coverage